Surgical drape with integral emi shielding

ABSTRACT

A sterile drape positionable covering medical equipment, such as between a robotic manipulator and a sterile surgical instrument. The drape is formed of a flexible sterile material, with conductive ink printed on the flexible material. The drape provides both a sterile barrier and a shield against electrostatic discharge or electromagnetic interference.

This application is a continuation of U.S. application Ser. No.16/932,654, filed Jul. 17, 2020, which is a continuation in part of U.S.application Ser. No. 16/732,307, filed Dec. 31, 2019, which claims thebenefit of the following US Provisional applications: U.S. 62/874,988,filed Jul. 17, 2019 and U.S. 62/787,254, filed Dec. 31, 2018. U.S.application Ser. No. 16/932,654 further claims the benefit of USProvisional application Nos.: U.S. 62/874,988, filed Jul. 17, 2019, U.S.62/875,003, filed Jul. 17, 2019, U.S. 62/874,985, filed Jul. 17, 2019,and U.S. 62/874,982, filed Jul. 17, 2019.

TECHNICAL FIELD OF THE INVENTION

The present invention relates to the field of surgical devices andsystems, including those using electromechanical actuation.

BACKGROUND

There are various types of surgical robotic systems on the market orunder development. Some surgical robotic systems use a plurality ofrobotic arms. Each arm carries a surgical instrument, or the camera usedto capture images from within the body for display on a monitor. Typicalconfigurations allow two or three instruments and the camera to besupported and manipulated by the system. Input to the system isgenerated based on input from a surgeon positioned at a master console,typically using input devices such as input handles. Motion andactuation of the surgical instruments and the camera is controlled basedon the user input. The image captured by the camera is shown on adisplay at the surgeon console. The console may be located patient-side,within the sterile field, or outside of the sterile field.

The robotic arms/manipulators include a portion, typically at theterminal end of the arm, that is designed to support and operate asurgical device assembly. The surgical device assembly includes asurgical instrument having a shaft and a distal end effector on theshaft. The end effector is positionable within a patient.

The instruments are exchangeable during the course of the procedure,allowing one instrument to be removed from a manipulator and replacedwith another. Typical sterile practice is to provide sterile surgicalinstruments, and to drape the manipulator with a sterile surgical drapeto prevent the sterile instrument from contacting non-sterile surfacesof the manipulator.

This application describes a sterile drape that may be used for thatpurpose, or for other types of robotic manipulators or sterileequipment. It provides a low cost and efficient means of shielding aninstrument driver from ESD or EMI generated by high energy instrumentsand adding additional functionality to the distal drape on a surgicalrobotic arm.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a robot-assisted surgical system onwhich the configurations described herein may included;

FIG. 2 is a perspective view of a robotic manipulator arm with thereceiver and instrument assembly mounted to it;

FIG. 3 are a perspective view showing the receiver of FIG. 2 and thesurgical instrument separated from the receiver;

FIG. 4 shows the surgical instrument with the base removed;

FIG. 5 shows the proximal part of the surgical instrument;

FIG. 6 is similar to FIG. 5, but shows a portion of the housing removed;

FIG. 7 is similar to FIG. 6, but shows a portion of the upper carriageremoved;

FIG. 8 shows the receiver of FIG. 2;

FIG. 9 is similar to FIG. 8 but shows a portion of the arm removed;

FIG. 10 is a side elevation view of the carriage and motor assemblies ofone arm of the receiver;

FIG. 11 is an alternate embodiment of a carriage for the instrumentbase;

FIGS. 12 and 13 are perspective views of alternate embodiments ofcarriages for one of the arms of the receiver;

FIGS. 14 and 15 are top plan views of the receiver, showing it in theopen and closed positions, respectively;

FIG. 16 is a perspective view showing the instrument mounted to thereceiver;

FIG. 17 is a perspective view showing the lever and linkages of thereceiver;

FIG. 18 is similar to FIG. 15, but shows a portion of the receiverhousing removed to allow the expansion mechanism to be seen;

FIG. 19 is a side elevation view of the instrument and lever of FIG. 17and the associated motor;

FIG. 20A is a perspective view showing the receiver as it is beingdraped;

FIG. 20B is similar to FIG. 16 but shows the drape in place;

FIG. 21 is a perspective view of the drape connector;

FIG. 22 is a rear plan view of the base of the instrument;

FIG. 23 is a perspective view of an alternative embodiment of the base;

FIG. 24 is similar to FIG. 23, but shows a portion of the housingremoved;

FIG. 25 is a perspective view showing one of pulley mechanisms andsprings of the embodiment of FIG. 23.

FIG. 26A shows an example of a drape having integral EMI shielding;

FIG. 26B is a cross-section of a portion of the drape shown in FIG. 26A;

FIG. 26C is similar to FIG. 26B, but shows an embodiment includingelectrical connectors and terminations incorporated into the drape

FIG. 27 is similar to FIG. 16 and further shows a graphical userinterface disposed on the manipulator end effector.

FIG. 28 is similar to FIG. 27, but illustrates features for providedforce feedback to a user during manual repositioning of the manipulator.

DETAILED DESCRIPTION

Although the shielded drape describe herein may be used on a variety ofrobotic surgical systems, or on other surgical equipment besides roboticsurgical equipment, this description with first describe one type ofsystem with which the drape may be used.

Referring to FIG. 1, in the illustrated system, a surgeon console 12 hastwo input devices such as handles 17, 18. The input devices 12 areconfigured to be manipulated by a user to generate signals that are usedto command motion of a robotically controlled device in multiple degreesof freedom. In use, the user selectively assigns the two handles 17, 18to two of the robotic manipulators 13, 14, 15, allowing surgeon controlof two of the surgical instruments 10 a, 10 b, and 10 c disposed at theworking site (in a patient on patient bed 2) at any given time. Tocontrol a third one of the instruments disposed at the working site, oneof the two handles 17, 18 may be operatively disengaged from one of theinitial two instruments and then operatively paired with the thirdinstrument, or another form of input may control the third instrument asdescribed in the next paragraph. A fourth robotic manipulator, not shownin FIG. 1, may be optionally provided to support and maneuver anadditional instrument.

One of the instruments 10 a, 10 b, 10 c is a camera that captures imagesof the operative field in the body cavity. The camera may be moved byits corresponding robotic manipulator using input from a variety oftypes of input devices, including, without limitation, one of thehandles 17, 18, additional controls on the console, a foot pedal, an eyetracker 21, voice controller, etc. The console may also include adisplay or monitor 23 configured to display the images captured by thecamera, and for optionally displaying system information, patientinformation, etc.

A control unit 30 is operationally connected to the robotic arms and tothe user interface. The control unit receives user input from the inputdevices corresponding to the desired movement of the surgicalinstruments, and the robotic arms are caused to manipulate the surgicalinstruments accordingly.

The input devices 17, 18 are configured to be manipulated by a user togenerate signals that are processed by the system to generateinstructions used to command motion of the manipulators in order to movethe instruments in multiple degrees of freedom and to, as appropriate,control operation of electromechanical actuators/motors that drivemotion and/or actuation of the instrument end effectors.

Sensors may optionally be used to determine the forces that are beingapplied to the patient by the robotic surgical tools during use. Forexample, a force/torque sensor on the surgical robotic manipulator maybe used to determine the haptic information needed to provide forcefeedback to the surgeon at the console. U.S. Pat. No. 9,855,662,entitled Force Estimation for a Minimally Invasive Robotic SurgerySystem, describes a surgical robotic system in which sensors are used todetermine the forces that are being applied to the patient by therobotic surgical tools during use. It describes the use of a 6 DOFforce/torque sensor attached to a surgical robotic manipulator as amethod for determining the haptic information needed to provide forcefeedback to the surgeon at the user interface. In the presentlydisclosed embodiments, a sensor of this type may be optionally bepositioned on or just proximal to the receiver 104. The surgical systemallows the operating room staff to remove and replace the surgicalinstruments 10 a, b, c carried by the robotic manipulator, based on thesurgical need. When an instrument exchange is necessary, surgicalpersonnel remove an instrument from a manipulator arm and replace itwith another.

In general, the assembly includes a surgical instrument having a baseconfigured such that its driven members (which receive mechanical driveinput to actuate functions of the instrument's end effector) aredisposed on more than one side, face, facet or plane of a base at theproximal end of the instrument. The base is one that in use is receivedby an arm within which is electromechanical or hydraulic actuators thatdrive mechanical outputs. To maintain sterility of the surgicalinstrument, the system is designed to facilitate use of a surgical drapepositioned between the base of the instrument and the correspondingmechanical drive outputs on the arm. Positioning the instrumentactuators on more than one side, facet, face or plane of the instrumentaids in spreading out the forces and deflections imparted by theseactuators on the drape, allowing transfer of multiple mechanical inputsto the instrument while preserving the drape.

Referring to FIGS. 2 and 3, this application describes an assembly 100of a surgical instrument 102 and a receiver 104. The receiver 104 isconfigured to removably receive the instrument 102. The receiver may bemounted to a support or manipulator 15, which may be a roboticmanipulator that robotically manipulates the instrument 102 in one ormore degrees of freedom during a procedure, or a support that remainsstationary during the course of surgery embodiments of a surgicalinstrument for a robotic surgical system. When the surgical instrument102 and receiver 104 are assembled, the receiver transfers motiongenerated by electromechanical actuators (e.g. motors orhydraulic/pneumatic actuators) in the receiver 104 or the arm 15 tomechanical actuators of the instrument to cause motion of a part of theinstrument. Examples of types of motion include, without limitation,articulation in one or more degrees of freedom (pitch, yaw), bending inone or more degrees of freedom, end effector roll, jaw actuation, etc.As discussed above, the surgeon moves the input devices 17, 18 (FIG. 1)to provide inputs into the system, and the system processes thatinformation to develop commands for the relevant electromechanicalactuators in order to move the instruments and, as appropriate, operatethe instrument end effectors.

The surgical instrument 102 includes an elongate shaft 106, which ispreferably rigid but which may be flexible or partially flexible inalternative systems. An end effector 108 is positioned at the distal endof the shaft 106, and a proximal body or base assembly 110 is at theproximal end. The base assembly 110 (which will also be referred to asthe “base”) may include an enclosed or partially enclosed structure suchas a housing or box, or it may be a frame or plate. The base 110includes mechanical input actuators 112 exposed to the exterior of thesurgical instrument 102. In FIG. 3, two actuators 112 are exposed at afirst lateral face of the base 110. A second two actuators 112 areexposed at the second, opposite, lateral face of the base 110,preferably but optionally in a configuration identical or similar to theconfiguration shown in FIG. 3. See the rear view of the base 110 shownin FIG. 22.

Each of the actuators 112 is moveable relative to the base 110 betweenfirst and second positions. In the specific configuration shown in thedrawings, the actuators are longitudinally moveable relative to thehousing between a first (more distal) position and a second (moreproximal) position such as that shown in FIG. 3. The direction ofmotion, however, is not required to be longitudinal and can extend inany direction.

In this configuration, the base assembly thus has four drive inputs 122exposed to its exterior. In this configuration the base has two parallelplanar faces, with two of these inputs positioned on each of the faces.While it may be preferred to include the inputs on opposite sides of theproximal body, other arrangements of inputs on multiple faces of theproximal body can instead be used. Each of these configurationsadvantageously arranges the drive inputs in a way that maximizes thedistance between control inputs, minimizing stresses in the steriledrape that, as discussed below, is positioned between the proximal bodyand the receiver 104.

Referring to FIG. 4, drive cables 114 extend through the shaft 106 tothe end effector 108. Many different types of instruments having any ofa variety of functions may be used in the disclosed system. Theinstrument depicted in the drawings is the type described incommonly-owned co-pending application Ser. No. 16/732,306, entitledArticulating Surgical Instrument, filed Dec. 31, 2019 (Attorney Ref:TRX-12700R), which is incorporated herein by reference. It makes use offour drive cables 114 two of which terminate at one of the jaw membersand the other two of which terminate at the other jaw member. This canbe two cables looped at the end effector (so each of the two free endsof each cable loop is at the proximal end) or it can be four individualcables. As described in the co-pending application, the tension on thecables is varied in different combinations to effect pitch and yawmotion of the jaw members and jaw open-close functions. Otherinstruments useful with the system will have other numbers of cables,with the specific number dictated by the instrument functions, thedegrees of freedom of the instrument and the specific configuration ofthe actuation components of the instrument. Note that in thisdescription the terms “tendon,” “wire,” and “cable” are used broadly toencompass any type of tendon that can be used for the described purpose.

The four cables extend to the base 110 assembly. In this embodiment,where the base includes a housing, the cables extend from the shaft 106into the housing where they are engaged to the actuators 112. FIG. 6shows the base with a portion of the housing removed to allow a clearerview of the actuators 112. Each actuator 112 includes a carriage 118moveable along a rail 120. In this embodiment these structures areoriented for longitudinal movement of the carriage, but in others motioncan be in a different direction. A portion of the carriage 118 isexposed through a window in the base, and includes a drive input ormember 122 that extends laterally from the carriage and that mayoptionally extend through the outermost plane of the window (see FIG.5). In FIG. 7 the carriage for the upper actuator is partiallydisassembled, showing that the proximal end of a cable 114 is mounted tothe carriage 118. The cable may extend around a pulley or through acable path defined by features of the base assembly. In thisconfiguration, a second cable end is similarly connected to the carriage118 of the lower actuator in FIG. 7, and the remaining two cable endsare connected to the carriages at the opposite face (not shown) of thebase 100. In this way, the base assembly is arranged to have actuators112 exposed at at least two sides or faces of the base. Each actuator112 is connected to one of the cables 114 so that movement of theactuator in a first direction relative to the base increases tension onthe corresponding cable, and movement of the actuator in a second,different (or opposite) direction decreases tension on that cable. Inthe illustrated embodiment, movement of an actuators carriage 118 in aproximal direction increases or decreases (depending on the routing ofthe cable) tension on that cable, and movement of the carriage in adistal direction has the opposite effect on the cable tension.

In this embodiment, an extension spring 124 is connected between thecarriage 118 and a supporting structure of the base (in this case to theouter housing 126 or a partition 128 that divides the interior of thehousing into two laterally adjacent regions). Application of force tothe carriage to actively move the carriage in the direction against thespring force (in this case the distal direction) increases the tensionon the corresponding cable. When the applied force is released, thespring force moves the carriage back to or towards a home position andreduces the tension on the cable. In other embodiments, the carriage mayinstead be actively moved in both directions in lieu of the use ofspring force for one direction of motion.

Referring to FIG. 8, the receiver 104 of the illustrated embodiment hasa generally U-shaped cross section, having two elongate sides and a seatspanning between the two sides. The sides of the “U” are formed by apair of distally-extending arm sections 130 a, 130 b, giving thereceiver an opening into which the base 110 is received when the systemis assembled (FIG. 3). Drive members 132, which will also be referred toas “drive outputs,” extend inwardly from the arm sections 130 a, b. Theyare positioned so that when the instrument is mounted to the receiver104, each drive input member 122 of the instrument (FIGS. 5 and 6) is incontact with a corresponding one of the drive output members 132. Twodrive members 132 are visible in FIG. 8. Two others extend from arm 130b but are obscured in the drawing. In FIG. 9, a portion of the arm 130 ais removed to show that the drive members 132 are carried by carriages134 housed within the arms 130 a, 130 b. Motors 136 within the receiver104 (FIG. 10) drive linear movement of the carriages 134, and thus thedrive members 132, along their respective arm sections 132 a, b.

The type of contact between the drive members 132 of the receiver andtheir counterpart driven members 122 of the instrument is selected basedon the nature of the drive motion that is transferred to the drivemembers 122. In the linear drive configuration shown, the components maybe configured so that a carriage of the instrument can be pushed,pulled, or both pushed and pulled, by the corresponding drive componentof the receiver. Additionally, different carriages may be configureddifferently, with some only pushed and others only pulled (or some othercombination of push, pull, and bi-directional drive).

Where motion is driven in a single direction, contact between the drivemembers 132 and the driven members 122 is only needed in the directionof motion. In FIGS. 3-10, the drive members 132 and the driven members122 are configured so that the drive members 132 push the driven membersin the distal direction, but need not pull the driven members in theproximal direction due to the presence of the springs 124 discussed inconnection with FIG. 7. Thus, the face or region of each drive member132 facing the direction of motion (here the distal direction) contactsthe driven member 122. Thus, in this example, it is not necessary thatthe drive members and driven members be mated to one other or otherwiseengaged, although they could be. Instead, these members 122, 132 can besimply configured to have opposed surfaces (which may optionally beplanar) that contact one other. If motion was driven in the proximal butnot distal direction in this embodiment, the proximal face of the drivemember would contact the driven member.

In other embodiments motion of a driven member is driven in twodirections. In a linear drive arrangement such as is shown in thedrawings, this might mean that the drive member can both pull and pushthe driven member. In such embodiments, the drive member and drivenmember are configured to be engaged, mated, or otherwise designed to bein contact regardless of the direction of motion. For example, FIG. 11shows an alternative carriage 120 a for the instrument, which includes adriven member 122 a shaped to mate with the drive member 132 (FIG. 10).

FIG. 12 shows receiver carriages on which the drive members 132 a arecomprised of the walls of a female receptacle shaped to receive a drivenmember 122 of the type shown in FIG. 5. FIG. 13 shows receiver carriageshaving two different drive member designs. On the upper carriage thedrive member 132 is similar to those previously discussed. On the lowercarriage the drive member 132 a is comprised of the walls of a femalereceptacle shaped to receive a driven member 122 of the type shown inFIG. 5. In this configuration, the upper carriage might drive thecorresponding driven member in a single direction (push or pull), whilethe lower carriage might drive the corresponding driven member in bothpush and pull.

The receiver 104 may be one that expands to receive the base 110. Inthis embodiment, the receiver 104 is moveable from a closed position toan open position by increasing the separation between the arms 130 a,130 b. Once moved to an open position, any instrument held by thereceiver can be removed, and the base of a first or replacementinstrument may be received. The receiver is also moveable to reduce theseparation between the arms as it moves from the open position to aclosed position in which the base is captured 110 by the receiver 104.When in the closed system with a base 110 between the arms 130 a, b, thedrive inputs 122 of the base are operatively engaged (albeit notnecessarily physically engaged as discussed above) with the driveoutputs 132 of the receiver.

Expansion may be achieved in various ways. In the example shown in thedrawings the arms 130 a, 130 b pivot between the opened position (FIG.14) and the closed position (FIG. 15). In other configurations they maymove in parallel. When the receiver is closed to engage the base of theinstrument, the arms of the receiver 104 reach around both sides of thebase 110 to retain the base and to position the drive outputs where theywill move the drive inputs to actuate degrees of freedom or otherfunctions of the instrument as described.

The receiver may be selectively opened and/or closed manually orelectromechanically my moving the arms towards/away from another. In thefirst embodiment, the arms 130 a, 130 b are pivoted relative to theirproximal ends by a rotatable lever or knob 138 having linkages 140spiraling outwardly from it. When the lever/knob is manually rotated ina first direction, the linkages 140 cam the arms 130 a, b to the openposition. Rotating the lever/knob in the opposite direction cams thearms to the closed position. In addition, or as an alternative, thelinkages 140 may be rotated by actuation of a motor 142. A switch 144 onthe receiver 104 may be used by a surgical assistant to activate themotor 142 to readily open and then close the receiver during aninstrument exchange.

The system may include features to facilitate alignment and retention ofthe instrument adapter while the actuator assembly of the manipulatorarm is open. Examples include tabs 146 on the base 110 or receiver 104that are received in corresponding seats 148 (FIG. 20) of the receiver104 or base 110. The proximal face of the base 110 may additionallyinclude alignment features. FIG. 22 shows female parts 150 (e.g.recesses, divots, holes or similar alignment features) that receive maleparts 150 (FIG. 21) as discussed in connection with the drape, below. Assuch, this embodiment has engaging and/or controlling features on threesides of the base 110. It should be understood that control points(drive inputs) may exist on any side of the base and may be actuated byeither the electromechanical actuators of the receiver/manipulator, orby operating personnel at the bedside. Additionally, these controlpoints may share axes, have parallel axes, slide linearly along the sameplane, or may be a combination of movements that are not related (i.e.not planar, parallel or sharing the same axis).

Lastly, it is not required that the base have defined planes orinterface points. For example, an adapter body may be spherical orcylindrical in nature, where the control points are arranged across thesurface(s) of the body.

A second embodiment is similar to the first, having a “U” construction,but instead of angling the two sides of the “U” to reach the openposition, the sides expand while keeping the internal surfaces parallel.In this embodiment, a four-bar mechanism can be used, in concert with alever or knob system or motor to drive the opening and closing of thesystem.

Each of these concepts allows expansion of the space between the “U”sides, and this feature enables the acceptance of varying widths ofbases for instruments, cameras, or other adapters (e.g. a removableadapter on the proximal end of the camera or instrument, allowingcameras or instruments from various manufactures to be used with thesystem). For instruments having bases of different widths, the systemwould identify the instrument and close down the appropriate amount tohold the instrument base or adapter rigidly. For example, a non-contactreed switch board could be used to identify instruments or adapters ofvarying widths. One digital reading would result in a closure to a 30 mmspace between the arms 130 a, b, while another may result in 40 mm. Fora mechanical solution, a lever system could be used where theinstruments push with varying distances on the lever system. Forexample, a lever system may allow inputs from 0-4 mm, where 0 mm isfully open and 4 mm is fully closed. One instrument may push 4 mm toresult in a 30 mm space between the arms 130 a, b, or full closure,while another may push 3 mm to result in a 40 mm space.

It should be noted that the shape and size of the “U” and in the spacedefined by the arms 130 a, b can be adjusted to accommodate a widevariety of instruments or adapters. Additionally, while the “U” shapemay be preferable for this application, other shapes having at least twopartially opposing sides may be used, where the sides may not haveparallel, opposing faces.

A further advantage of the “U” shaped embodiments is the ability toengage some instruments such that the instrument shares the axis of thereceiver, but to engage others such that the instrument does not sharethe axis. For example, the receiver engaged with a camera system may beable to hold the camera so that the camera shaft and the receiver axesare at an angle, up to 90 degrees, relative to each other. This wouldallow the camera and light cords to pass “though” the receiver, ratherthan having to pass around it. Other instruments, such as harmonicenergy devices or staplers may benefit from this feature as well, whileallowing the mass of the instrument to be as close to the 6 DOF forcesensor as possible.

Referring to FIGS. 20A and 20B, the receiver 104 is typically anon-sterile component that is covered by a sterile drape 154 or barrierbefore attachment of the sterile surgical instrument. At the interfacebetween the drive elements and the driven elements, the motion describedabove is communicated through the drape to control the degrees offreedom of the instrument. In one embodiment of a drape 154, the drapematerial is shaped to fit with the geometry of the receiver, having two“fingers” to cover the arms 130 a, b that open and close. It is optimalto ensure that the drape is properly oriented with the receiver and thatthe area for the instrument is clear for instruments to be engaged andremoved. In this embodiment, the drape includes an embedded plastic“drape connector” 156 adhered such that the connector has geometryextending to both sides of the drape. One side of the drape connectorincludes mating pins, posts, conical elements etc. that mate with femaleparts (e.g. recesses, conical divots, holes or similar alignmentfeatures) in the seat of the receiver 104, while the other mates withthe female parts 150 on the proximal face of the base. The mating pinsmay provide retention force to both the manipulator and instrument aswell as the orientation of the drape and instrument.

In this embodiment, the central male element 152 of the drape connectorhas two annular rings that allow mating geometry to snap into, providingthe retention force. In this case, the mating geometry may be a coiledspring. During the draping process, the drape is positioned over thearms 130 a, b of the receiver. The inward-facing face of the drapeconnector 156 is positioned so that the male members are inserted intothe female parts at the seat of the receiver, and the outward-facingface of the drape connector is similarly snapped into engagement withthe proximal face of the instrument base 110.

Because the drape connector extends through both sides of the drape, itmay be used as a sterile conduit for a variety of mechanical,electrical, optical or other tasks. A non-inclusive list of thesefeatures or tasks is included below.

-   -   The drape connector may be used to provide electrical signals        including power, ground, communication, etc. between the robotic        manipulator and the instrument        -   This electrical energy may be used to power instrument            recognition devices such as RFID transceivers, cameras,            proximity sensors or switches (including hall sensors and            reed switches). These devices may be able to determine what            instrument shaft is attached to a given base/adapter, while            allowing certain bases/adapters to be common for a variety            of instrument types.        -   This energy could also power sensors such as force and            torque or displacement devices as a means of measuring            activity within the instrument or the instrument adapter.            These measurements may enable better instrument control or            user feedback such as force feedback or tactile responses.        -   This electrical energy could be used for monopolar/bipolar            or advanced energy devices, eliminating the need for cables            that can get wrapped around the manipulator or instrument            when the manipulator is rotated.    -   The drape connector may be used to provide optical signals or        light transmission between the robotic manipulator and        instrument        -   These optical signals may be used for communication purposes            including instrument identification via spectroscopy or            other methods        -   These optical signals could be mated with a rod lens scope            to gain an intraoperative viewpoint without requiring a            camera head as with other endoscopes        -   The optical signals could be coupled with sensors such as            fiber optics for measuring deflection, for example. This            deflection could be used to interpret force on an instrument            or adapter.

The drape connector may be used for other features as well. In thisembodiment, for example, the proximal surface of base has a flush portthat is intended to be used to clean the instrument adapter andinstrument shaft after a surgical procedure. If left open during theprocedure, this flush port is a leak pathway for CO2 to exhaust from theoperative site. The drape connector is used to plug this flush port,eliminating the leak pathway, while also eliminating components in theinstrument adapter such as check valves or elastomeric flush portcovers.

Second Embodiment

As discussed, in the first embodiment, the assembly is configured totransfer linear motion of a push/pull variety from the drive outputs tothe drive inputs, but other embodiments can be envisioned in whichrotary, or a combination of linear and rotary motion, can betransferred. See, for example the second embodiment of FIGS. 23-25,which show an alternate base 110 b. Here each of the drive elements 122b extends from a pulley 123 rotatably mounted to a structure (e.g.partition) within the base. Each cable is coupled to a corresponding oneof the pulleys 123. The linear motion of the drive outputs 132 (FIG. 8)causes rotation of the corresponding pulleys 123 and thus alteration ofthe tension in the cables. This effects movement or actuation of the endeffector as described in connection with the first embodiment. Anexpansion spring 125 may serve to return the pulley to the unbiasedposition when the drive member removes or reduces the force against thedriven member, in a manner similar to that described with the firstembodiment.

Drape Incorporating EMI Shielding

The manipulator and related components may be covered by drapes using avariety of material types suitable for surgical draping. One example ofa drape that may be used will next be described in connection with FIGS.26A-26C. It should noted that this drape may be used to drape thedisclosed components, to drape components of alternative surgicalrobotics systems other than those described above, and to drape manyother components of sterile equipment (other than surgical roboticsystems).

If used with the embodiments described here, the drape might bepositioned as shown in FIGS. 20A and 20B, over the receiver 104 of thatembodiment before insertion of the proximal body 110 into the actuatorassembly.

The drape 200 is formed of a stretchable, multi-ply polymer containingintegral circuits printed with electrically conductive (or insulating)inks 204. The printed circuits may serve as a flexible Faraday cage toshield the contained device from electrostatic discharge and/orelectromagnetic interference. The ink may be printed in a mesh patternor other pattern suitable to create Faraday shielding. The printedcircuits may also serve as passive functional circuits such ascapacitive sensing (buttons), resistance sensing (strain measurement),antennas (RFID), etc. The printed traces may be sandwiched betweenlaminations 202 of drape material. Where electrical signals are to betransferred from one side of the drape to the other, the printed tracesmay be connected to conductive pads 205 for transferring electricalsignals into and out of the printed circuits. Likewise, the printedcircuits may connect to molded in components and features such asconnectors 210 and vias 208. The drape may take any form that is desiredand may be formed from a flat sheet (or roll) of material.

Drape 200 provides a low cost and efficient means of shielding aninstrument driver from ESD or EMI generated by high energy instrumentsthat may be mounted to it. In shielding applications, this methodreduces the complexity of designing electrical seals (such as springs)between moving interfaces in the device and eliminates the need to addelectrically conductive plating to external covers. It may also be usedto span gaps in the enclosed device which may otherwise be difficult toshield. It also can add functionality to the distal drape on a surgicalrobotic arm.

Graphical User Interface on Manipulator

A graphical user interface may be positioned on the manipulator. Thisfeature may be applied to any surgical robotic manipulator and while itis suitable for use with the configurations described above, it isequally suitable for use on components of other surgical roboticssystems.

In some robotic systems, for the convenience of surgical personnel, eachmanipulator may be individually identified using color coding, colorcoded tape, numbers, or other markings in one or more locations on eachmanipulator. Additionally, the cart supporting each manipulator mayinclude a screen for displaying error messages, and a series of lightsto indicate machine status.

At times during the course of a surgical procedure, it may becomenecessary for a surgical assistant or other operating room employee toreposition the manipulator. This may be done by applying a manual forceto the robotic arm and physically moving the robotic arm to the desiredorientation or position. This may be a purely manual activity as withthe prior art system, or it may be a power assisted activity. In eithercase, it would be advantages to notify the user about forces on theinstrument when the user is performing a manually driven motion.Typically, to move the manipulator when it is not being activelyteleoperated from the surgeon console, the user takes an action (e.g.simultaneously depresses two buttons on the manipulator) to unlock themanipulator so s/he can manually move the end effector of themanipulator to a desired position.

This section describes embodiments that consolidate functions ofinstrument status and error messages communication, manipulatoridentification and an easily accessible touch point for manipulation ofthe arm by a user, at a single site on the manipulator arm that iseasily accessible by the user regardless of the manipulator's endeffector orientation.

A first embodiment includes a surgical robotic system comprising atleast one manipulator arm. As shown in FIG. 27, the manipulator arm(e.g. 13, 14, 15 of FIG. 1) has an end effector distal to at least onedegree of freedom of the manipulator arm. In this specific embodiment,the receiver 104 is part of the end effector. In use, as describedabove, a surgical instrument 106 is removably attachable to the endeffector.

On the end effector is a capacitive display screen 212 on which avariety of information can be displayed. In this embodiment, the displayscreen 212 is cylindrical, and extends around the body of the endeffector. The screen may be configured to change colors, display text oricons or other GUI items in order to communicate machine status, armidentification, instrument identification, etc to the user. Icons couldbe displayed and selected via touching the capacitive screen to performtasks such as calibration, homing or docking the end effector to thetrocar.

Additionally, touch gestures by the user on the capacitive screen couldelicit a response by the machine. For example, touching in two pointsspaced apart could unlock the degrees of freedom to allow manipulationor manual movement of the manipulator about its joints. Swiping couldchange between menus or tell the machine to go to a specific state(draping, etc). Gesture interaction with the display could also be usedto cause the system to place the manipulator in a state for, and/orcause activation of the manipulator's actuators to configure themanipulator in a position or orientation suitable for executingdifferent tasks (docking an instrument, exchanging instruments,calibration, homing, storage, draping, etc)

In a preferred configuration the touch screen wraps entirely around theend effector. In this configuration, the capacitive points can always beaccessed easily. Additionally, the inclusion of an inertial measurementunit (IMU) on or in the end effector provides feedback to the systemindicating the orientation of the end effector. Based on this feedback,the system would maintain or alter the position and orientation ofmessages and menus displayed on the GUI so that from the viewpoint of anoperator the messaging/menus are always in a specific orientation,regardless of the rotation of the end effector relative to the operator.In order words, the IMU would detect the orientation of the endeffector, and a processor of the system would select a region of thescreen that would be visible to a user in that orientation, and causethe relevant messaging and menus to be displayed in that region and,preferably, in an easily readable orientation for the user.

This feature enhances convenience of the surgical system use byincluding all of the available information about the system on displayat a location that is easily accessible at the patient-side. Touchpoints may be wrapped around the entire end effector, meaning they arealways accessible and in the same location (from the user'sperspective), regardless of the end effector's orientation. The displaymay include color changing displays that allow the use of color toindicate different operative states, or identification of different armsto the users.

Force Notification During Manually Driven Motion of a Manipulator

As discussed in the above section, at times during the course of asurgical procedure, it may become necessary for a surgical assistant orother operating room employee to reposition the manipulator. This may bedone by applying a manual force to the manipulator and physically movingthe manipulator to the desired orientation or position. This may be apurely manual activity as with some commercially available systems, orit may be a power assisted activity. In either case, it would beadvantageous to notify the user about forces on the instrument when theuser is performing a manually driven motion.

As also discussed in this application, a force/torque sensor, which maybe a 6 DOF force/torque sensor, may be attached to the manipulator andused for determining the haptic information needed to provide forcefeedback to the surgeon at the user interface. FIG. 28 an end effectoras described above. Within the manipulator, in a region proximal to theinstrument position, is a 6 DOF force/torque sensor 214 which, asdiscussed above, is used to measure forces experienced by the surgicalinstrument so that the system can communicate those forces to a user viaa haptic interface. Proximal to the sensor 214 is at least onenotification component 216, which may be at least one of a vibrationaltransducer, and a visual indicator or light emitter. Where a vibrationaltransducer is used, positioning it on the manipulator in a positionproximal to the sensor 214 helps avoid interference with forcemeasurements of the sensor 214. The visual indicator may be a light, LEDor collection of LEDs, image display, etc. If a GUI of the typedescribed in the previous section is used, it may be part of that GUI.These components are used to alert the user to the presence of forcesagainst the instrument while the system is being manually repositioned.

During a manual driven motion (motion performed by the user controllingthe movement of the arm with his/her hand on the arm), when a force isapplied on the instrument attached on the arm, a vibration and a visualalert from the light emitter are emitted. This alerts the person movingthe arm that the instrument is contacting tissue or another structure,so that additional precautions can be taken if warranted. This would beparticularly beneficial if, for example, an instrument is being insertedinto a trocar positioned at the incision site while the instrument isengaged to the arm.

The visual indicator may be configured to provide directionalinformation to the user to advise the surgeon. For example, it mayprovide a visual indication of the direction the arm should be moved inorder to alleviate the forces between the instrument and the tissue orother object. If the light emitter is a ring of lights or LEDsencircling a portion of the arm, a quadrant of those lights might beilluminated to mark the direction the user should push the arm in, orthe direction of the force against the instrument. If a flexible displayor GUI is used, one or more arrows or other symbols, icons, text etc.may be displayed for the same purpose. In some embodiments, the systemmay be configured to cause the amplitude/frequency of the vibration andthe intensity/blinking of the light to be proportional to the measuredforce on the force sensor 214.

During a remote driven motion (motion performed by the user controllingthe arm remotely using one of the user input devices 17, 18), when aforce is applied to the instrument attached on the arm (or if a forceexceeding a defined threshold is applied), a visual alert from the lightemitter may be emitted.

This feature may be used for any robotic manipulator and is not limitedto the embodiments described here. In general, it will be part of asurgical robotic system comprising a manipulator arm including a forceand torque sensor, a surgical instrument mountable to the manipulatorarm, a haptic user input device. The system includes at least oneprocessor, and at least one memory storing instructions executable bysaid at least one processor to do the following: in response to usermanipulation of the haptic user input device, cause the manipulator armto move the surgical instrument, in response to signals from the sensorduring user manipulation of the haptic user interface, causing actuatorsof the haptic user input device to apply force feedback to the hapticuser input device, and in response to signals from the sensor duringmanual user movement of the manipulator arm, activate a vibrationtransducer on the arm. The instructions may be further executable by theat least one processor to, in response to signals from the sensor,activate a visual alert on the arm.

Note that the vibrational transducer may be used to provide other typesof feedback to the user in addition to or as an alternative to forcefeedback. For example, if the system is configured to use theforce/torque to determine the fulcrum point for instruments passingthrough the incision as described in U.S. Pat. No. 9,855,662, thevibrational alert may be activated to notify the user that the fulcrumdetermination process is complete and the fulcrum has been set.

While certain embodiments have been described above, it should beunderstood that these embodiments are presented by way of example, andnot limitation. It will be apparent to persons skilled in the relevantart that various changes in form and detail may be made therein withoutdeparting from the spirit and scope of the invention. This is especiallytrue in light of technology and terms within the relevant art(s) thatmay be later developed. Moreover, features of the various disclosedembodiments may be combined in various ways to produce variousadditional embodiments.

Any and all patents, patent applications and printed publicationsreferred to above, including for purposes of priority, are incorporatedherein by reference.

We claim:
 1. A sterile drape positionable covering non-sterile medicalequipment, the sterile drape comprised of a flexible drape material withconductive ink printed thereon.
 2. The sterile drape of claim 1, whereinthe printed conductive inks comprise printed circuits.
 3. The steriledrape of claim 2, wherein the printed circuits form a flexible Faradaycage.
 4. The sterile drape of claim 1, wherein the conductive ink isarranged to prevent passage of electrostatic discharge orelectromagnetic interference from a first side of the drape to a second,opposite, side of the drape.
 5. The sterile drape of claim 1, whereinthe ink is printed in a mesh pattern.
 6. The sterile drape of claim 2,wherein the printed circuits form passive functional circuits.
 7. Thesterile drape of claim 6, wherein the passive functional circuits arecapacitive sensing circuits.
 8. The sterile drape of claim 6, whereinthe passive function circuits are resistance sensing circuits.
 9. Thesterile drape of claim 8, wherein the resistance sensing circuits arestrain sensing circuits.
 10. The sterile drape of claim 6, wherein thepassive functional circuits are antennas.
 11. The sterile drape of claim10, wherein the passive functional circuits are RFID circuits.
 12. Thesterile drape of claim 1, wherein the drape comprises at least twolaminations of drape material, and wherein the ink is sandwiched betweenthe laminations.
 13. The sterile drape of claim 1, wherein the drapeincludes a first side and a second, opposite, and wherein the drapeincludes conductive pads on the first and second sides.
 14. A method ofusing a surgical robotic system, comprising: positioning a sterile drapeon a robotic manipulator, and mounting a sterile surgical instrument onthe robotic manipulator, with the sterile drape forming a sterilebarrier between the robotic manipulator and the surgical instrument, andwherein the sterile drape further forms a shield against electrostaticdischarge or electromagnetic interference.